Claim Form Instructions

THE DEADLINE TO SUBMIT A CLAIM FORM IS AUGUST 15, 2025.

Considerations and Preparation:

• To be considered for eligibility for a Distribution Payment from the Impact Theory Fair Fund, you must provide the information requested in this online Claim Form. Failure to submit the completed form and any required documentation through the Fund Administrator's online claim system so that it is submitted and received on or before 11:59 p.m. Eastern Standard Time on the August 15, 2025 Claims Bar Date, set forth in the Plan may result in your claim being rejected and you being precluded from any recovery from the Impact Theory Fair Fund.


• Timely submission of your completed Claim Form does not guarantee you will be eligible for a Distribution Payment from the Impact Theory Fair Fund or that you will be compensated for your claimed loss.


• Please fill out this Claim Form completely. If you fail to provide all relevant information, the Fund Administrator may reach out to you to request additional documentation to support your claim. Failure to completely fill out the Claim Form or timely provide all requested documentation will result in rejection of your claim.


• Providing a valid email address is required as part of the Claim Form. Failure to provide a valid email address that remains valid throughout the administration of the matter may result in rejection of your claim. If you must change your email or any other contact information, please contact the Fund Administrator and request a secure link to transfer your updated information. Please DO NOT send any updated contact information via email. Contact information for the Fund Administrator is located on the Contact page of this website.


• This Claim Form requires you to provide information required to substantiate the claim, including but not limited to: copies of third party documentary evidence of purchases and dispositions of the Security during the Relevant Period, as well as holdings of the Security at pertinent dates; valid and authenticated wallet and/or exchange connections as part of an online claim; copies of account statements and/or documentation of centralized exchange transactions; attributable exchange and/or wallet account information in the form of screenshots or videos as visual proof of ownership; any requested explanatory information or attestations; and/or any required personal identification information. If you are not a U.S. Person, as defined in Section IV of the Claim Form, you must also submit a completed IRS Form W-8BEN, W-8BEN-E, or other W-8 series form, which can be found by visiting the following IRS website: www.irs.gov/forms-instructions.


• Submitting your Claim Form using the Fund Administrator's online claim system, which includes digital wallet and exchange connectors designed to retrieve your transactions during the Relevant Period, allows you to forgo the manual entry of your claimed transactions as part of a paper Claim Form. Online submissions may also result in faster review and consideration of your claim. If necessary (if you are unable to submit online and/or you have lost relevant credentials associated with wallets and/or exchanges required as part of an online claim), you may download a paper Claim Form from the Important Documents page or request a copy of the paper Claim Form from the Fund Administrator via email at info@ImpactTheoryFairFund.com or by calling 833-285-3401, and submit the completed form, with all documentation, by mail to the address provided on the Claim Form.


• In preparation for submitting your Claim Form online, please have all relevant wallet and/or exchange browser plug-ins updated and/or any corresponding credentials or devices used for two-factor authentication or similar verification ready. Click here to view a full list of Claim Form compatible wallets and centralized exchanges.

If you have any questions, please contact the Fund Administrator via email at info@ImpactTheoryFairFund.com, or by calling 833-285-3401.